Manitoba Health

Required Documents for Review of New Submissions to the HIPC 

HIPC Submission Form
 
Complete all questions in the form.  Applications that are not completed in full will not be reviewed by the HIPC.  Referencing the protocol and/or attachments is not acceptable as an alternative to completing each section of the HIPC submission form.  All information must be typewritten.  Do not use a font size smaller than 10 points. 

Please use simple, non-technical terms (e.g., avoid medical jargon and/or acronyms).  The Committee is made up of members with expertise across a range of areas, including public representatives.  It is helpful if the project is explained in lay terms so that all members can review the submission with a clear understanding of its content.

 1 Original + 10 Copies

Data Extraction Form  -  List the specific information/variables that will be extracted and collected from each administrative database.

 10 copies
 

Proof of Funding  -  Submit a copy of a letter of support from the granting agency.  If grant funding has not been awarded at the time of submission to the HIPC, a letter of support for alternative funding must be attached.  E.g. example, if internal department funds will be used in lieu of grant funding, a letter of support from the department head is required.

 1 copy
 

Ethics Approval  -  Submit a copy of all ethics board approvals.  Note that a submission to ethics may be made concurrently with a submission to the HIPC; however, projects will not receive final approval until the appropriate documentation is received by the HIPC Coordinator.

 1 copy

Project Protocol -  The Committee requires that the information provided in the project protocol is captured in the appropriate sections of the HIPC submission form.  In the case of discrepancy between the project protocol and the information provided in the HIPC submission form, the latter will prevail. 

 1 copy

Other Approval(s) (WRHA, CCMB, SBGH, etc.)  -  (if applicable) It is the responsibility of the researcher to obtain all necessary & applicable approvals from the trustees of data that will be linked/merged with data held by the Government of MB.

 1 copy

AMC- HIRGC Approval  -  (if applicable) Stratification of analysis or outcomes according to First Nations status requires written notification to AMC-HIRGC.  Submit a copy of the letter of support.

 1 copy

Participant Information and Consent Form(s) - (if applicable)

 10 copies

Letter(s) of Invitation to Participate - (if applicable) - Such documentation may be applicable for projects involving correspondence with potential participants that is provided or mailed out.

 10 copies

Questionnaires & Other Material(s) to be given to participants - (if applicable) - Such documentation may be applicable for projects involving a survey or questionnaire that is mailed out or provided to potential participants.

 10 copies

Other Supporting Documents

Consult the HIPC Coordinator